Influence of race on diagnosis in adolescent psychiatric inpatients.

OBJECTIVE: To examine racial differences in 352 psychiatric inpatients, aged 12 to 18 years, at a state hospital facility that accepted admissions from throughout South Carolina. These were all the adolescent admissions during an entire calendar year (1988). There were 101 African-American and 251 white subjects. METHOD: The data were abstracted from patients' hospital medical records and nursing incident reports. DSM-III-R discharge diagnoses were assigned to five non-mutually exclusive groupings (organic/psychotic, mood/anxiety, disruptive, personality, substance abuse). Racial differences were analyzed using chi 2, logistic regression, and T statistics. RESULTS: African-Americans were more likely to be involuntarily committed at the time of admission (p = .010). Organic/psychotic diagnoses were much more frequent in African-Americans (odds ratio = 3.15, p < .003). Whites (p = .0347) were almost two times more likely to receive mood/anxiety diagnoses even when controlling for gender, type of admission, and comorbid diagnoses. Substance abuse was more often diagnosed in whites (odds ratio = 5.46, p < .0001). CONCLUSIONS: This study identifies significant racial differences in the discharge diagnoses of psychiatrically hospitalized adolescents. African-Americans have fewer mood/anxiety and substance abuse diagnoses but significantly more organic/psychotic diagnoses. Some of these differences may reflect ethnocentric clinician bias in the diagnostic assessment of youth from differing cultural/racial backgrounds.

Experimental manipulation of cocaine craving by videotaped environmental cues.

Thirteen male patients consecutively admitted to an inpatient drug and alcohol rehabilitation hospital with the primary diagnosis of crack cocaine dependence were shown a 30-minute videotape that included salient environmental cues intended to elicit cocaine craving. The subjects were tested before and after the videotape by the use of a continuous 20-cm analogue visual instrument that asks them to rate their perceived degree of craving, mood, energy, and wellness. Only craving showed a statistically significant change from pretest to posttest. Correlations among the four separate ratings suggest that mood and craving are different dimensions that independently contribute to one's general sense of well-being. This study demonstrates that cocaine craving can be induced in a group setting by presenting certain visual and auditory cues on a video monitor. The procedure of obtaining self-ratings in response to videotaped environmental cues could be easily incorporated into research methods designed to assess pharmacologic efficacy in reducing the intense craving that reinforces addiction.